Breast-feeding reduces risk of obesity in children

Question: I was a little surprised in your article about infant obesity that you didn't mention the preventive effect of breast- feeding, in view of all the recent articles about it. -- D.F., RN, Utah Valley, Utah

Answer: You are right. I've always felt that pudgy breast-fed babies are less likely to be overweight later in life than formula- fed babies who gain excess weight in the first year.

It always seemed to me that the "fat" breast-fed babies quickly lost weight in the second year, once they became mobile, while heavy formula-fed babies more often went on to be overweight children.

In recent years, research has piled up supporting my clinical observations. There are many reasons why this may be the case. Breast milk is a remarkable substance, and none of the formula companies have managed to reproduce it. Even more remarkable is the fact that its contents actually change over time, adjusting to the changing needs of a growing baby!

But there may be other reasons, too. For example, parents may tend to urge a baby to drink from a bottle until a certain amount has been consumed, or until it has been finished off altogether. A breast-feeding baby, though, is finished when he or she is full. Some scientists believe that this is an early opportunity to learn about hunger and fullness cues and to respect them.

There is a reason, though, why we didn't mention the virtues of breast milk in our answer to a question from a grandparent of a 3- month-old. By that age, breast-feeding, if never started, is unlikely to be an option, and we wouldn't ever want to blame a parent for a choice that we had no basis for understanding and no right to judge.

Question: How much of an impact does the use of steroids have on current problems of child obesity?

My daughter was very thin and active at 5 years old. After a couple of weeks of steroid use, prescribed due to a rash, she ballooned up overnight. Within six months she is now considerably overweight.

Was this weight gain the result of the prescription? Or could she have suddenly put on weight another way? Her eating habits did not change. --Name and address withheld

Answer: Pediatric obesity is a national epidemic, but most children who are obese or overweight have not been treated with steroids. Steroids are well-known to cause weight gain, along with a number of other problematic side effects, but the number of children with weight gain due to steroids is very small relative to the number of children in this country who are overweight or obese. Steroids are not the cause of our obesity problem.

Without knowing more about how much medication your child was given, for how long, and why, it is difficult to know whether the steroid treatment was the cause of her weight gain.

Sometimes steroids given by mouth are used for very serious allergic reactions with accompanying rashes for a short period of time. Usually, though, major side effects such as massive weight gain do not occur without longer courses of medication, though there are exceptions to this.

Sometimes, weight gain due to steroids involves fat deposits in distinct locations, such as on the upper arms and at the base of the neck between the shoulders. Because of the many serious side effects of steroids, these medications are usually not prescribed except for equally or even more serious conditions that justify these risks. However, for many of these, steroids can still be the best or the only treatment, and often well worth the risk.

We would advise you to consult your doctor to be sure that you understand exactly why your child was treated with steroids, and to check for other causes of such sudden weight gain. There are many causes for rashes -- allergy is only one, and certain rashes can sometimes signal systemic illness causing other symptoms and physical changes as well.

If your child is still taking steroids, you certainly should talk with the doctor about this question. But never stop oral steroid medication cold turkey without close supervision by a physician.

When taken for a certain period of time, which can vary from one individual to another, steroids can suppress the production of the body's own natural steroid-like hormones, which are necessary for normal functioning. Unless steroids are given for a very short period of time, they are usually gradually tapered in order to prevent a sudden drop in this hormone, and to allow the body to begin to produce its own steroid-like hormones again.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 609 Greenwich St., 6th Floor, New York, NY 10014-3610. Questions may also be sent by e-mail to: nytsyn- families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider. ? T. Berry Brazelton, M.D., and Joshua Sparrow, M.D. Distributed by New York Times Special Features

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